Dignity Health Merger Raises Questions

A proposed merger between Dignity Health and Catholic Health Initiatives has raised concerns about access to care for women, transgender, and low-income patients, according to the American Civil Liberties Union. Nurses in Dignity’s California hospital system are also worried that the merger could disrupt labor union contracts and job security.

At the same time, the University of California, San Francisco is collaborating with Dignity to offer a digital platform to help patients navigate the healthcare system, prompting criticism of USCF for partnering with an entity that the ACLU claims restricts care for certain groups.

San Francisco-based Dignity Health, California’s largest hospital provider, and Catholic Health Initiatives, a national nonprofit healthcare supplier, announced the proposed merger last December. The plan is being reviewed by the California Attorney General’s Office following a series of hearings held throughout the state at which members of the public expressed concerns that it may act to lessen health care provision. Dignity Health has pledged that there’ll be no service reductions for at least five years.

Merger concerns focus primarily on the Catholic proprietorship of Dignity and CHI, and that the affiliation will jeopardize access to reproductive health services, end-of-life practices, and treatment of LGBTQ patients, due to the Catholic Church’s Ethical and Religious Directives. Though Dignity ended its religious affiliation with the Church in 2012 for some of its hospitals, the merger could act to fully reinstate the relationship. Many Dignity Health facilities already abide by the Ethical and Religious Directives; procedures such as tubal ligations and vasectomies aren’t performed there.

“We’re concerned that this proposed merger could exacerbate the denials of care that we are already witnessing,” said Phyllida Burlingame, Reproductive Justice and Gender Equity Director at the ACLU of Northern California.

The ACLU is pursuing two legal cases against Dignity Health. The first was filed on behalf of a patient who was refused a postpartum tubal ligation by a Dignity hospital, despite a doctor’s recommendation that the procedure be performed to prevent future pregnancies.

The second ACLU lawsuit claims that the healthcare provider canceled a hysterectomy surgery once it was determined that the patient was transgender. The lawsuit asserts discrimination; the hospital states that the procedure is contrary to the Catholic anti-sterilization directive, although it’s routinely performed at the hospital for patients who aren’t transgender.

Karen Camacho, ACLU Organizing Coordinator, told The San Francisco Examiner, “This is a merger between two Catholic hospital systems, which generally follow the Ethical Religious Directives that prohibit many crucial reproductive health services, including contraception, abortion and fertility treatments. Transgender patients have had gender affirming surgeries denied on religious grounds.”

“This promise that they’re going to maintain levels of care for five years is one we can’t count on,” Burlingame added. “These hospitals receive public funds and serve the general public, and they need to provide care that meets the standard of care for all services.”

The merger also calls into question whether pensions for nurses will be retained, if union contracts for hospital workers will continue in the long term, and whether there’ll be adverse impacts on staffing levels and the work environment.

“We are concerned about the impact of this merger upon the services we provide, and want a guarantee that these hospitals will remain open for at least 15 years, with no services eliminated, and that there is no cut or change in the way charity care is accounted for,” said Joe Domingos, a National Nurses United spokesperson, referring to free or discounted care offered to low-income patients at its facilities.

In a press release, Dignity Health stated, “There will be no reduction in any service currently provided at any Catholic and any other-than-Catholic hospital as a result of our alignment, which is made clear in the California Attorney General’s independent Health Impact Reports. That includes women’s health services. Any service that is offered today will be offered tomorrow to all members of our community.”

UCSF, which is collaborating with Dignity to launch a digital patient platform next spring, is trying to steer clear of the controversies. When asked about the nurses’ union contract concerns, Kristen Bole, UCSF Director of Clinical Communications and Public Affairs, said, “That has nothing to do with us at all.”

“Dignity Health will play no role in direct patient care for UCSF through the new digital platform, nor will its directive influence UCSF care in any way,” added Shelby Decosta, UCSF Senior Vice President and Chief Strategy Officer.

The UCSF/Dignity collaboration will offer “a state-of-the-art digital engagement platform that will provide information and access to patients when and where they need it as they navigate primary and preventive care, as well as more acute or specialty care,” according to a UCSF statement. The cloud-based platform, created by Dignity Health for use in its 39 hospitals, is being designed to offer patients a user-friendly interface with the healthcare system, via a web-based and mobile application, and is being tailored to fit the needs of UCSF patients.

Joann Wardrip, Dignity Health Media Relations Manager, stressed that “the religious affiliation won’t have any bearing on the collaboration, because it’s purely technological in nature. Use of the digital app won’t result in any religious influences on healthcare or experiences for UCSF’s patients.”